| NPI | 1619985181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY 006215) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 006215) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CT 000816) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2024-11-09 |