| NPI | 1720095706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QH0100X Clinic/Center, Health Services (Licence: NY 006104-01) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N006104-01) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2007-08-22 |