| NPI | 1629029558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO0001789) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: NJ 38R101564000) |
| 183500000X Pharmacist (Licence: FL P518795) | |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2020-07-09 |