| NPI | 1194068395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 10596) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: DC PO10000131) |
| Enumeration Date | 2013-04-05 |
| Last Update Date | 2025-05-26 |