| NPI | 1558374124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC004509L) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA 885) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2025-12-19 |