| NPI | 1316344138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E5403) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00337300) |
| 213E00000X Podiatrist (Licence: NY N006848-1) | |
| Enumeration Date | 2014-11-21 |
| Last Update Date | 2023-11-27 |