| NPI | 1376760579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: NY 067) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: PR 067) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2008-12-01 |