| NPI | 1114546793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00375500) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N007365) |
| Enumeration Date | 2020-04-13 |
| Last Update Date | 2023-12-21 |