| NPI | 1427154988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00134100) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC002395L) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2009-08-18 |