| NPI | 1942221270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00266800) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC004363L) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2023-06-26 |