| NPI | 1992709430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NJ 25MD00199400) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY NOO4606) |
| 213E00000X Podiatrist (Licence: MA PD1985) | |
| 213E00000X Podiatrist (Licence: MI 5901002193) | |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2010-08-25 |