| NPI | 1356303416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO3898) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ MD002632) |
| 213E00000X Podiatrist (Licence: NY N006124) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2020-12-14 |