| NPI | 1871001818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY 003515) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00152500) |
| Enumeration Date | 2018-01-11 |
| Last Update Date | 2018-01-11 |