| NPI | 1669860003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY SN006772-1) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00323800) |
| Enumeration Date | 2015-01-08 |
| Last Update Date | 2018-02-13 |