| NPI | 1780093765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07001248A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 135000862) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 07001248A) | |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2021-03-23 |