NPI | 1356345912 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ MD002621) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ MD002621) |
Enumeration Date | 2005-06-10 |
Last Update Date | 2024-03-26 |