| NPI | 1629018627 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: NY N005473) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N005473) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2010-08-23 |