| NPI | 1811379605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: FL PO4114) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NJ 25MD00353200) |
| Enumeration Date | 2015-06-29 |
| Last Update Date | 2023-02-03 |