| NPI | 1649260563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NJ 25MD00231100) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NY N005169-1) |
| Enumeration Date | 2005-10-22 |
| Last Update Date | 2018-04-10 |