NPI | 1912429002 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD00001452) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD001452) |
Enumeration Date | 2017-07-11 |
Last Update Date | 2024-04-02 |