| NPI | 1457353856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY NY003551) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL 1495) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2012-09-30 |