| NPI | 1922136779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N004629) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY N004629) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2020-02-17 |