| NPI | 1629111521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NY N006012) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NJ 25MD00283700) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2015-03-04 |