| NPI | 1194188565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00355800) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY 006891) |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2020-07-14 |