| NPI | 1184948176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N005973) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CT 000779) |
| Enumeration Date | 2010-03-18 |
| Last Update Date | 2020-07-13 |