| NPI | 1578577979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N0037141) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00298200) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2011-09-02 |