| NPI | 1558711812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E5533) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 006987) |
| Enumeration Date | 2016-06-17 |
| Last Update Date | 2022-10-05 |