| NPI | 1699843839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N004465) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD000708) |
| 213E00000X Podiatrist (Licence: PA SC006096) | |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2011-02-24 |