| NPI | 1114003589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00133300) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO835) |
| 213E00000X Podiatrist (Licence: PA SC001587L) | |
| Enumeration Date | 2006-10-28 |
| Last Update Date | 2007-07-09 |