| NPI | 1437128295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC001504L) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: PA SC001504L) |
| 213ER0200X Podiatrist Radiology (Licence: PA SC001504L) | |
| 213ES0000X Podiatrist Sports Medicine (Licence: PA SC001504L) | |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2016-10-20 |