| NPI | 1891220836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N007108-01) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA EL6779) |
| 213E00000X Podiatrist (Licence: CT 1027) | |
| Enumeration Date | 2017-04-27 |
| Last Update Date | 2020-08-27 |