| NPI | 1578534426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC002518L) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NJ 25MD00175300) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2009-11-17 |