| NPI | 1154345924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY N005978) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NJ 25MD00278900) |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2014-02-06 |