| NPI | 1255726071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NC 706) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006652) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: NC 706) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006652) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2023-08-07 |