| NPI | 1144428848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36.003522) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC-006003) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2010-09-21 |