| 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 |