NPI | 1902108053 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD001162) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO 3499) |
Enumeration Date | 2010-11-23 |
Last Update Date | 2016-02-02 |