| NPI | 1629422118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00379500) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO4106) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2024-03-18 |