| NPI | 1245539923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY 006538) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC006143) |
| Enumeration Date | 2011-03-21 |
| Last Update Date | 2015-06-18 |