| NPI | 1871570739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N005829-01) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N0058291) |
| 213E00000X Podiatrist (Licence: TN 592) | |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2023-06-04 |