| NPI | 1366440406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208600000X Surgery (Licence: PA SC002781L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC002781L) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2022-07-01 |