| NPI | 1568951481 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA 5850) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 007176) |
| Enumeration Date | 2018-05-07 |
| Last Update Date | 2025-05-07 |