NPI | 1902821242 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: GA 000931) |
Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: GA 000931) |
Enumeration Date | 2006-07-13 |
Last Update Date | 2011-01-28 |