| NPI | 1114922994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY NOO3165-1) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N003165-1) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2010-05-06 |