| NPI | 1518036698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N0041801) |
| Additional Taxonomies | 171100000X Acupuncturist (Licence: NY 001028-1) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2012-02-27 |