| NPI | 1285613604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00201600) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N003146-1) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2008-02-01 |