| NPI | 1023012770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO4619) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N003323) |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2026-05-14 |