| NPI | 1073538443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 005362) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: NY 005362) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2008-07-18 |