| NPI | 1790712966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY NOO4428) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 1925) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2008-06-18 |