| NPI | 1548213291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N003776-1) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00274000) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2011-11-08 |