| NPI | 1518960855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TN DPM0000000637) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001010) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TN DPM0000000637) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2018-05-17 |