NPI | 1205828787 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00223300) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ MD002233) |
Enumeration Date | 2005-08-19 |
Last Update Date | 2015-11-24 |