| NPI | 1770680357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N003492-1) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36002080S) |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2017-04-14 |