| NPI | 1962810846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO4570) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC006583) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NJ 25MD00341800) | |
| Enumeration Date | 2014-07-23 |
| Last Update Date | 2024-06-11 |