| NPI | 1992115026 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 07001285A) | 
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA sc006550) | 
| Enumeration Date | 2014-04-28 | 
| Last Update Date | 2023-02-15 |