| NPI | 1164473427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC003089L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ MD01795) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2011-04-06 |