| NPI | 1346249133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N004154-3) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CT 000465) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2007-07-08 |