| NPI | 1376509844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC001941L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ MD1184) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2010-03-25 |