| NPI | 1659668846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA N/A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00322000) |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2019-02-26 |