NPI | 1629161526 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY noo2613) |
Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: NY noo2613) |
Enumeration Date | 2006-10-02 |
Last Update Date | 2022-07-21 |