| NPI | 1912977364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: NY NOO5412) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: NY N005412) |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2018-03-07 |