| NPI | 1023170719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY N003878-1) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NY N003878-1) |
| Enumeration Date | 2006-12-16 |
| Last Update Date | 2011-11-28 |