| NPI | 1700292877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AZ POD-000896) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006500) |
| 282N00000X General Acute Care Hospital (Licence: NY 65P97423) | |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2020-04-30 |