| NPI | 1639270044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000773) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N005002) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2016-02-23 |