| NPI | 1649546284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 99053018A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD001156) |
| Enumeration Date | 2012-03-28 |
| Last Update Date | 2012-08-17 |