| NPI | 1437195567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07001010A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 884-25) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2014-02-04 |