| NPI | 1982847612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: NJ 25MD00151600) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NJ 25MD00151600) |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2023-08-20 |