| NPI | 1023181195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ MD002165) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 005052) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2019-05-28 |