| NPI | 1710623061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 007484) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E6219) |
| Enumeration Date | 2022-05-10 |
| Last Update Date | 2026-05-21 |