| NPI | 1093142614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: PA SC007525) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC007525) |
| 213E00000X Podiatrist (Licence: DE E10000233) | |
| Enumeration Date | 2013-09-27 |
| Last Update Date | 2025-01-30 |