| NPI | 1588674592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N004820) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CT 000937) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: ME POD1041) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 004820) | |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2021-07-07 |