NPI | 1770715237 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 006584) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA sc006142) |
Enumeration Date | 2009-08-18 |
Last Update Date | 2014-08-18 |