| NPI | 1689668196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ md002461) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY n0055321) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2016-08-18 |