| NPI | 1801942065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ MD02222) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NJ MD02222) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NJ MD02222) | |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2009-05-13 |