| NPI | 1740691450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N006759-1) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00337600) |
| Enumeration Date | 2014-05-15 |
| Last Update Date | 2022-07-21 |