| NPI | 1851327761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N005256-1) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 005256) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2017-02-07 |