| NPI | 1700157039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MA 2383) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00312200) |
| Enumeration Date | 2012-01-18 |
| Last Update Date | 2021-05-05 |