| NPI | 1972505238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N004124) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NY N004124) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2008-05-28 |