NPI | 1922082957 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 119) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07000335A) |
213ES0000X Podiatrist, Sports Medicine (Licence: KY 00119) | |
332BC3200X Durable Medical Equipment & Medical Supplies, Customized Equipment | |
Enumeration Date | 2005-12-02 |
Last Update Date | 2015-10-06 |