| NPI | 1366473845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N0041131) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NY N0041131) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NJ MD001821) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2008-04-17 |