| NPI | 1720081078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TN 597) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: GA POD000970) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TN DPM0000000597) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2022-07-14 |