| NPI | 1790707057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00118100) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC003575L) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2012-01-10 |