| NPI | 1407946601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY N005232) |
| Additional Taxonomies | 213EP0504X Podiatrist, Public Medicine (Licence: NY N005232) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NY N005232) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2010-02-22 |