| NPI | 1467453654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC-003461-R) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MA 2467) |
| 213E00000X Podiatrist (Licence: PA SC-003461-R) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2018-07-10 |