| NPI | 1275984643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 41000353A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 244152) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2020-12-04 |