| NPI | 1245319771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY 002603) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: NY 002603) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: NY 002603) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 002603) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2007-07-08 |