| NPI | 1710409289 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA 5684) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 005017) |
| Enumeration Date | 2017-07-17 |
| Last Update Date | 2020-09-28 |