| NPI | 1538146352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N736991) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CT P00365) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2019-02-07 |