| NPI | 1851451397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N003471-1) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO1643) |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2023-01-17 |