| NPI | 1902995012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N0030771) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 4629) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2007-07-08 |