| NPI | 1255384442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07000951A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 00329) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2014-02-19 |