| NPI | 1871598326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 2793) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NY 2793) |
| 213E00000X Podiatrist (Licence: FL PO 0001680) | |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2007-11-21 |