| NPI | 1164485827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 005336) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N005336) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2021-04-05 |