| NPI | 1285839134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC005771) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NY N006304-2) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: NY n006304-1) | |
| Enumeration Date | 2007-06-20 |
| Last Update Date | 2020-10-09 |