| NPI | 1619049855 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY N005536) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N005536) |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NY N005536) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2018-01-08 |