| NPI | 1972505626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: NY N004608) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NY N004608) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2008-12-02 |