| NPI | 1982788972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY N005575) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E4423) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2015-01-27 |