| NPI | 1811336522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00329900) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NJ 25MD00329900) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00329900) | |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2024-04-11 |