| NPI | 1740283951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N003128) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NY N003128) |
| 213E00000X Podiatrist (Licence: FL PO-2413) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2014-01-06 |