| NPI | 1467475087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N003995-1) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC005739) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2008-05-08 |