| NPI | 1326027426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N005881) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA 000992) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2013-06-28 |