| NPI | 1467029934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 007507) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5951001433) |
| Enumeration Date | 2021-06-04 |
| Last Update Date | 2026-03-27 |