| NPI | 1548288749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: PA SC002113L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA Sc002113L) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2008-10-02 |