| NPI | 1992896948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: VT 056-0000180) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N006103) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2010-04-21 |