| NPI | 1528381274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: TX 3101) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: PA SC006334) |
| Enumeration Date | 2010-03-09 |
| Last Update Date | 2022-08-29 |