| NPI | 1396743753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CT 822) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY N005856-1) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NJ MD002431) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2011-09-02 |