| NPI | 1366468100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00112900) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC001887L) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2011-09-21 |