| NPI | 1710953088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD000924) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N004948) |
| Enumeration Date | 2006-02-27 |
| Last Update Date | 2024-04-26 |