| NPI | 1457571325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC003096L) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: PA SC-003096L) |
| 213E00000X Podiatrist (Licence: PA SC003096L) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2021-09-29 |