| NPI | 1770586133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: NY 003245) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 003245) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2007-10-26 |