| NPI | 1194784116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 002721) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N002721) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2019-06-19 |