| NPI | 1811974140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N0046801) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VT 0560000158) |
| Enumeration Date | 2005-12-28 |
| Last Update Date | 2023-04-13 |