| NPI | 1538543947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3930) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO3930) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N006733-1) | |
| Enumeration Date | 2015-07-15 |
| Last Update Date | 2019-08-08 |