| NPI | 1871605147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07000406A) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: IN 07000406A) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 07000406A) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2015-12-21 |