| NPI | 1548697162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00330000) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NY N006841-1) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N006841-1) | |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2024-05-15 |