| NPI | 1902330400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 01780) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0103301376) |
| Enumeration Date | 2017-04-12 |
| Last Update Date | 2025-06-14 |