| NPI | 1548279623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 2451) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL 686) |
| 213E00000X Podiatrist (Licence: MA 1415) | |
| 213E00000X Podiatrist (Licence: CA E1753) | |
| Enumeration Date | 2006-08-06 |
| Last Update Date | 2007-07-08 |