| NPI | 1265759054 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07001158A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07001158B) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2017-04-03 |