| NPI | 1518575257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00389100) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC007115) |
| Enumeration Date | 2020-07-20 |
| Last Update Date | 2025-08-27 |