| NPI | 1285618058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC002545L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC002545L) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2008-04-14 |