| NPI | 1972122117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MA PDF2549) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NJ 25MD00364900) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 007330) | |
| Enumeration Date | 2020-04-08 |
| Last Update Date | 2024-04-10 |