| NPI | 1679666911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WV 10395) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N006127) |
| Enumeration Date | 2006-09-30 |
| Last Update Date | 2008-04-22 |