| NPI | 1104897552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00153700) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ MD001537) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2015-06-30 |