| NPI | 1629462635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07001297A) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 41000347A) |
| 213E00000X Podiatrist (Licence: KY 244018) | |
| Enumeration Date | 2015-03-27 |
| Last Update Date | 2019-11-19 |