| NPI | 1619973484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 002372) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO0000549) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2008-03-03 |