| NPI | 1053402438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: NY 005093) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY 005093) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NJ 02607) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NJ 02607) | |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2012-11-16 |