| NPI | 1275797243 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 2045) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 1994543) |
| Enumeration Date | 2008-07-17 |
| Last Update Date | 2014-01-20 |