NPI | 1104981877 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N004792-1) |
Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NY N004792-1) |
Enumeration Date | 2006-12-23 |
Last Update Date | 2007-07-08 |