| NPI | 1124125562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X (Licence: NY N006379) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016-004384) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2016-01-19 |