| NPI | 1629033758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TN DPM0000000199) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07000408A) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2007-07-08 |