| NPI | 1215019161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N004141-1) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY N004141-1) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NY N004141-1) | |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2011-08-10 |