| NPI | 1366608580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: DE E1-0000187) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: PA SC003365L) |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2024-09-06 |