| NPI | 1619356466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 006924) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N0069241) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N006924-1) | |
| Enumeration Date | 2015-05-27 |
| Last Update Date | 2020-09-22 |