| NPI | 1942229786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 363AM0700X Physician Assistant Medical (Licence: NY N001420) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N0043401) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2016-01-15 |