| NPI | 1235242819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY NOO39896-1) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX 928) |
| Enumeration Date | 2006-08-16 |
| Last Update Date | 2012-09-19 |