| NPI | 1437293792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY N002070-1) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: NY 000115-1) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2017-02-22 |