| NPI | 1275721946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25md00294000) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: NJ 38mc00669600) |
| 213E00000X Podiatrist (Licence: NY N006213) | |
| 213E00000X Podiatrist (Licence: OH 003454) | |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2023-08-30 |