| NPI | 1316047020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: WV 248) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: PA SC-003441-L) |
| 332B00000X Durable Medical Equipment & Medical Supplies | |
| 335E00000X Prosthetic/Orthotic Supplier | |
| Enumeration Date | 2006-09-23 |
| Last Update Date | 2014-06-24 |