| NPI | 1194064675 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07001164A) | 
| Additional Taxonomies | 213ES0131X (Licence: NY P76610) | 
| 213E00000X Podiatrist (Licence: MI 5901002608) | |
| Enumeration Date | 2013-02-04 | 
| Last Update Date | 2025-09-17 |