| NPI | 1417061854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N004476) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00202500) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2021-04-12 |