NPI | 1871570739 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N005829-01) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N0058291) |
213E00000X Podiatrist (Licence: TN 592) | |
Enumeration Date | 2005-12-30 |
Last Update Date | 2023-06-04 |