| NPI | 1174559876 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 07001024A)  | 
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07001024A)  | 
| 213EP0504X Podiatrist, Public Medicine (Licence: IN 07001024A)  | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IN 07001024A)  | |
| 213ES0131X  (Licence: IN 07001024A)  | |
| Enumeration Date | 2006-06-24 | 
| Last Update Date | 2017-11-06 |