| NPI | 1356325526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N004227) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY N004227) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NY N004227) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2010-08-06 |