| NPI | 1417356775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AZ POD-000877) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00329100) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00329100) | |
| Enumeration Date | 2014-08-22 |
| Last Update Date | 2024-06-23 |