| NPI | 1013103100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC005998) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NC 554) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: SC 616) | |
| Enumeration Date | 2007-09-21 |
| Last Update Date | 2011-07-15 |