| NPI | 1366737850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY 006422) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: NY 006422) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 006422) | |
| Enumeration Date | 2011-06-13 |
| Last Update Date | 2016-10-14 |