| NPI | 1699882506 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 183500000X Pharmacist (Licence: NY 33607) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NY N003820) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2009-05-06 |