| NPI | 1679533624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 222899) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N004780) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2014-08-15 |