| NPI | 1881752327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY N003017-1) |
| Additional Taxonomies | 2083P0011X Preventive Medicine Undersea and Hyperbaric Medicine (Licence: NY N003017-1) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2013-04-18 |