| NPI | 1184116584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: NY 007146) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 007146) |
| Enumeration Date | 2018-05-31 |
| Last Update Date | 2025-06-13 |