| NPI | 1568460509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: PA SC) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC004352L) |
| 213ER0200X Podiatrist Radiology (Licence: PA SC) | |
| 213ES0000X Podiatrist Sports Medicine (Licence: PA SC004352L) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC004352L) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: PA SC) | |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2019-03-11 |