| NPI | 1376809889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: LA 308231) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC006611) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NJ 25MD00326800) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY N006718) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2018-05-23 |