| NPI | 1588692974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: NY N006205) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00287600) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2017-01-24 |