| NPI | 1376222166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC007362) |
| Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
| 213ES0131X (Licence: PA SC007362) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC007362) | |
| Enumeration Date | 2023-07-18 |
| Last Update Date | 2026-07-23 |