| NPI | 1356369367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 004503) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CT 000562) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2007-07-08 |