| NPI | 1518129808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TN TN686) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC005863) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA sc005863) | |
| Enumeration Date | 2008-06-27 |
| Last Update Date | 2022-07-21 |