| NPI | 1760706436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N006632) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY 0066321) |
| Enumeration Date | 2010-03-24 |
| Last Update Date | 2019-07-10 |