| NPI | 1205232071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 006967) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: ME POD1094) |
| 213E00000X Podiatrist (Licence: CA E5334) | |
| 213E00000X Podiatrist (Licence: NY 006967) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5334) | |
| Enumeration Date | 2014-11-06 |
| Last Update Date | 2022-10-14 |