| NPI | 1851361414 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N004433) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: MA PD1905) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2008-02-12 |