| NPI | 1548290927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC004518L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: DE E10000157) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2016-12-15 |