| NPI | 1104268416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MA 2439) |
| Additional Taxonomies | 213ES0131X (Licence: NY P88852) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: MA 2439) | |
| Enumeration Date | 2013-07-28 |
| Last Update Date | 2026-05-14 |