| NPI | 1932112000 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 07001260A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MN 639) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA PO60507271) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OK 304) | |
| Enumeration Date | 2006-08-13 |
| Last Update Date | 2023-08-29 |