| NPI | 1275541773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MA 2127) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MA DPM00310) |
| 213E00000X Podiatrist (Licence: RI 2127) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: MA 2127) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2023-02-14 |