| NPI | 1578618583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N005892-1) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E4706) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC007319) | |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2023-09-13 |