| NPI | 1790129641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E5425) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006443) |
| 213E00000X Podiatrist (Licence: NY N006765-1) | |
| Enumeration Date | 2013-04-22 |
| Last Update Date | 2020-02-25 |