| NPI | 1922051556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NJ 25MD001125) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: NJ 25MD001125) |
| 213ES0131X (Licence: NJ 25MD001125) | |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2011-08-18 |