| NPI | 1356654529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CT 000930) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00320800) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 006624) | |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2015-10-13 |