| NPI | 1376896381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NV 1301) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: NJ 1301) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2014-01-08 |