| NPI | 1578503553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC-002493-L) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: PA SC-002493-L) |
| 213ES0000X Podiatrist Sports Medicine (Licence: PA SC-002493-L) | |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2013-10-18 |