| NPI | 1932337664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TN 728) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MS 80218) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2022-03-14 |