| NPI | 1811095961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: NY 005883) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY 005883) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2008-02-29 |