| NPI | 1124023353 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NJ 25MD00275700) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY N005953) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2009-04-10 |