| NPI | 1205821212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC001767L) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: PA SC001767L) |
| Enumeration Date | 2005-09-15 |
| Last Update Date | 2010-07-07 |