| NPI | 1073569133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NY 003732) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 003732) |
| 213ER0200X Podiatrist Radiology (Licence: NY 003732) | |
| 213ES0000X Podiatrist Sports Medicine (Licence: NY 003732) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: NY 003732) | |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2013-11-21 |