| NPI | 1053308478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC001969L) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: PA SC001969L) |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2012-02-21 |