| NPI | 1184731739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: FL 4494) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NY 004379) |
| 363A00000X Physician Assistant | |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2023-10-14 |