| NPI | 1356338453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N003458) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ MD01529) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2016-05-02 |