| NPI | 1063400877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC005575L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: DE E1-0000169) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2008-02-12 |