| NPI | 1124327309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00313500) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 65P71601) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006259) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00313500) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NJ 25MD00313500) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NJ 25MD00313500) | |
| Enumeration Date | 2011-03-27 |
| Last Update Date | 2015-08-07 |