| NPI | 1700888948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07000307) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IN 07000307) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2015-06-18 |