| NPI | 1376540021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N003884) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00171500) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2011-01-06 |