| NPI | 1356757645 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 01611) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0103301191) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2025-04-14 |