| NPI | 1205818820 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N005337) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NY N005337) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2010-12-06 |