| NPI | 1578588315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AZ 731) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC002015L) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2011-09-23 |