| NPI | 1326091141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC001855L) |
| Additional Taxonomies | 183500000X Pharmacist (Licence: PA RP1001946) |
| 213E00000X Podiatrist (Licence: PA SC001855L) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2020-12-08 |