| NPI | 1639526577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TN 857) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: LA POD.INTERN) |
| Enumeration Date | 2016-05-20 |
| Last Update Date | 2019-07-30 |