| NPI | 1598760100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N002750) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD001092) |
| Enumeration Date | 2005-06-20 |
| Last Update Date | 2012-07-27 |