| NPI | 1831208586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PR 093) |
| Additional Taxonomies | 213ES0131X (Licence: PR 093) |
| 213ES0131X (Licence: NJ MD2500) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2024-03-12 |