| NPI | 1053415778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY N002592) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N002592) |
| Enumeration Date | 2006-09-12 |
| Last Update Date | 2008-01-16 |