| NPI | 1174189369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 247707) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC007248) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2023-12-05 |