| NPI | 1598750937 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00267600) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NJ 25MD00267600) |
| 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NJ 25MD00267600) | |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2021-10-12 |