| NPI | 1255740320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00358600) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MA 2469) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY P93179) | |
| Enumeration Date | 2014-08-04 |
| Last Update Date | 2021-04-02 |