| NPI | 1396088803 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00365800) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N00721001) |
| 213E00000X Podiatrist (Licence: GA POD001311) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NJ 25MD00365800) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00365800) | |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2022-02-01 |