| NPI | 1679197131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07001433A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: KY 284787) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 07001433A) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 284787) | |
| Enumeration Date | 2020-06-01 |
| Last Update Date | 2023-11-15 |