| NPI | 1538163373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MA 1845) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: NY 002466) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2023-05-31 |