| NPI | 1487781589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NY N003415) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: NY NOO3415) |
| Enumeration Date | 2007-02-27 |
| Last Update Date | 2016-08-08 |