| NPI | 1225299175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY AN006347) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: NY AN006347) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2023-02-23 |