| NPI | 1750686580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: NY N006569) |
| Additional Taxonomies | 211D00000X Assistant, Podiatric |
| Enumeration Date | 2011-01-26 |
| Last Update Date | 2013-10-01 |