| NPI | 1245294503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY 006017) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NY 006017) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2009-01-26 |