| NPI | 1285764761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: VA 0103300851) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: SC 553) |
| 213E00000X Podiatrist (Licence: NY NO05808) | |
| Enumeration Date | 2007-03-06 |
| Last Update Date | 2012-04-13 |