| NPI | 1093383564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC007589) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070.024167) |
| Enumeration Date | 2021-06-11 |
| Last Update Date | 2025-08-06 |