| NPI | 1073623088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NJ 25MD00234500) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00234500) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NJ 25MD000234500) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NJ 25MD00234500) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2022-07-21 |