| NPI | 1245250612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00265900) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC004617L) |
| Enumeration Date | 2006-07-20 |
| Last Update Date | 2015-01-06 |