NPI | 1073520912 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00231900) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00231900) |
213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NJ 25MD00231900) | |
213ER0200X Podiatrist, Radiology (Licence: NJ 25MD00231900) | |
213ES0000X Podiatrist, Sports Medicine (Licence: NJ 25MD00231900) | |
Enumeration Date | 2006-08-02 |
Last Update Date | 2021-05-12 |