| NPI | 1073502076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: PA SC002981L) |
| Additional Taxonomies | 213ER0200X Podiatrist Radiology (Licence: PA SC002981L) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC002981L) | |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2020-11-04 |