| NPI | 1659630580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: NY N006480) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NJ 25MD00315700) |
| Enumeration Date | 2012-05-12 |
| Last Update Date | 2018-06-18 |