Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225000000X | Orthotic Fitter | C52107 | MD |
NPI | 1720386477 |
---|---|
Provider Name | Mr. Krishna Gidwani |
First Address | New Bedford, MA 02740-2104 |
Second Address | New Bedford, MA 02740-2104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/03/2011 |
Last Update Date | 10/06/2020 |