| NPI | 1386649515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N003271) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00213900) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2008-05-30 |