| NPI | 1902946015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ N005481-01) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 171100000X Acupuncturist | |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2025-09-19 |