| NPI | 1174502405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL P0857) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N2612) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2007-08-13 |