| NPI | 1457469801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N005539-1) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VT 056-0000170) |
| Enumeration Date | 2006-08-27 |
| Last Update Date | 2011-01-26 |