| NPI | 1417953647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: NJ 25MD00267000) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC003899L) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2022-02-28 |