| NPI | 1790116267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N006552-1) |
| Additional Taxonomies | 213ES0131X (Licence: NY N006552-1) |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2023-06-23 |