| NPI | 1942822911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MA PDF2545) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: MA 2545) |
| Enumeration Date | 2020-05-13 |
| Last Update Date | 2024-09-27 |