| NPI | 1558360891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: PA SC002370L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC002370L) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2012-09-14 |