| NPI | 1386058444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00348600) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NJ 25MD00348600) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 2253) | |
| Enumeration Date | 2014-06-17 |
| Last Update Date | 2022-09-01 |