| NPI | 1104800606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 005943) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC005724) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2024-03-08 |