| NPI | 1033103700 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ NJ25MD001319) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N003235-1) |
| 213E00000X Podiatrist (Licence: FL PO1371) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2007-07-08 |