| NPI | 1326153339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07001355A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD001315) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MA 1855) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2023-08-29 |