NPI | 1841221413 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 000709) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: KS 266) |
213E00000X Podiatrist (Licence: TN 791) | |
Enumeration Date | 2006-07-05 |
Last Update Date | 2025-03-17 |