| NPI | 1497195341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NC 627) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006463) |
| Enumeration Date | 2013-06-25 |
| Last Update Date | 2016-06-28 |