| NPI | 1376950113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25md00338000) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY P93821) |
| Enumeration Date | 2014-07-14 |
| Last Update Date | 2022-07-21 |