| NPI | 1629607130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00373400) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IN 41000417A) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 135.001077) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00373400) | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2023-08-07 |