| NPI | 1992706287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY NOO 37201-1) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 518-025) |
| Enumeration Date | 2005-08-09 |
| Last Update Date | 2011-12-21 |