| NPI | 1962475665 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 01312) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00385100) |
| Enumeration Date | 2006-02-12 |
| Last Update Date | 2025-03-16 |