| NPI | 1184913287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N006434) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO3965) |
| Enumeration Date | 2011-03-30 |
| Last Update Date | 2019-04-23 |