| NPI | 1780613265 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00101100) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC001621l) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2012-01-05 |