| NPI | 1336162221 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AR 236) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TN DPM269) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2016-04-28 |