| NPI | 1316967466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N005307) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ MD002497) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2015-08-08 |