| NPI | 1497819247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N004109) |
| Additional Taxonomies | 163W00000X Registered Nurse (Licence: NY 309257) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2011-02-24 |