NPI | 1902185051 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 1017-25) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: MN 850) |
213E00000X Podiatrist (Licence: WI 1017-25) | |
213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MN 850) | |
213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: WI 1017-25) | |
213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 850) | |
Enumeration Date | 2011-08-08 |
Last Update Date | 2021-05-18 |