| NPI | 1255733523 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY 213E00000X) |
| Additional Taxonomies | 111NN0400X Chiropractor Neurology (Licence: NY 111NN0400X) |
| Enumeration Date | 2014-09-18 |
| Last Update Date | 2014-09-18 |