| NPI | 1003816190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC002590L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL P0001587) |
| Enumeration Date | 2005-07-29 |
| Last Update Date | 2011-10-31 |