| NPI | 1437511912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: UT 11327341-0501) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 006775) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2019-12-10 |