NPI | 1487737599 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: NY NOO4960-1) |
Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY NOO4960-1) |
Enumeration Date | 2006-10-23 |
Last Update Date | 2017-02-28 |