| NPI | 1710095849 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N0055411) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO3859) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2023-10-05 |