| NPI | 1326242777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC004-513L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: DE E1-0000144) |
| Enumeration Date | 2007-06-11 |
| Last Update Date | 2007-07-08 |