| NPI | 1639262314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N004168) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 002444) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2008-04-28 |