| NPI | 1801071550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: ID P-142) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: ID P1423) |
| Enumeration Date | 2007-12-31 |
| Last Update Date | 2023-10-17 |