| NPI | 1407872302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N004237) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 2032) |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2015-03-12 |