NPI | 1821253386 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: IA 000811) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: MO 2011028644) |
Enumeration Date | 2008-07-24 |
Last Update Date | 2014-03-12 |