| NPI | 1366451841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 002553) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY 002553) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: NY 002553) | |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2008-04-29 |