| NPI | 1134376247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 01510) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006078) |
| Enumeration Date | 2008-08-20 |
| Last Update Date | 2022-01-11 |