| NPI | 1881380111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 007462) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC007453) |
| Enumeration Date | 2023-04-11 |
| Last Update Date | 2025-08-30 |