| NPI | 1972547156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: NJ 25MD00288100) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NY N005925) |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2016-06-17 |