| NPI | 1568777613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 007121) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NY X012429) |
| 213E00000X Podiatrist (Licence: CA 5707) | |
| Enumeration Date | 2010-08-13 |
| Last Update Date | 2020-12-09 |