| NPI | 1437155900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC005954) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC005954) |
| 213E00000X Podiatrist (Licence: MD 01517) | |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2024-09-16 |