| NPI | 1558772244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 006743) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY P89260) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2020-03-07 |