| NPI | 1639127053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207X00000X Orthopaedic Surgery (Licence: NY 1726592) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N0033481) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2008-03-13 |