NPI | 1851333553 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MD 00676) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: MD 00676) |
213ES0000X Podiatrist, Sports Medicine (Licence: MD 00676) | |
Enumeration Date | 2006-06-10 |
Last Update Date | 2008-02-20 |