| NPI | 1891782587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NY N004639) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00244000) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| Enumeration Date | 2005-09-29 |
| Last Update Date | 2016-11-30 |