NPI | 1629111521 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NY N006012) |
Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NJ 25MD00283700) |
Enumeration Date | 2007-02-14 |
Last Update Date | 2015-03-04 |