NPI | 1972512739 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MA 2142) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO 2808) |
Enumeration Date | 2006-08-07 |
Last Update Date | 2019-08-27 |