| NPI | 1700119336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N006818) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36003516) |
| 213E00000X Podiatrist (Licence: NY 6818) | |
| Enumeration Date | 2009-09-15 |
| Last Update Date | 2023-07-03 |