| NPI | 1003888298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY N005120) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NC 330) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC004333) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2019-08-19 |