| NPI | 1871607218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ MD103700) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC001895L) |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2013-07-15 |