| NPI | 1598767907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO3206) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00271200) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N005625) | |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2020-04-14 |