| NPI | 1972591758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ MD002458) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY N005344) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2007-07-09 |