| NPI | 1225020266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MD 00437) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC001738L) |
| Enumeration Date | 2005-08-16 |
| Last Update Date | 2009-05-08 |