| NPI | 1578880522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 006349) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NY 65 006349) |
| Enumeration Date | 2010-04-30 |
| Last Update Date | 2019-05-01 |