| NPI | 1114953676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ MD00240700) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC004298L) |
| Enumeration Date | 2006-06-24 |
| Last Update Date | 2013-07-22 |