| NPI | 1972664449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N006292) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: VA 0103300945) |
| 213E00000X Podiatrist (Licence: MA 1144) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2019-06-21 |