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 |