| NPI | 1194880047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: NY N005997) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: WV 10417) |
| Enumeration Date | 2006-12-22 |
| Last Update Date | 2024-02-07 |