| NPI | 1306129341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY R76156) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: NY R76156) |
| 213E00000X Podiatrist (Licence: NY R76156) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY R76156) | |
| Enumeration Date | 2011-09-26 |
| Last Update Date | 2011-09-26 |