| NPI | 1891778882 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N005680) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY n005680) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2015-01-20 |