| NPI | 1285743559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00196300) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N0046131) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-12-07 |