| NPI | 1962440164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00263100) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NJ 25MD00263100) |
| 213ER0200X Podiatrist, Radiology (Licence: NJ 25MD00263100) | |
| 213ES0131X (Licence: NJ 25MD00263100) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2022-07-15 |