| NPI | 1184618480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT P313) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL 1437) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CT P313) | |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2021-06-27 |