| NPI | 1689727323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N002683) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL 1005) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2010-03-04 |