| NPI | 1376565259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: DC PO1000070) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: CA E4788) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MD 01477) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NJ 25MD00288000) | |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2021-05-27 |