| NPI | 1043206923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N003180) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: NY N003180) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N003180) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2010-09-23 |