| NPI | 1366481038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X (Licence: NJ 25MD00209500) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC003506L) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2025-06-25 |