| NPI | 1588618524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC005917) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY N006107-1) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2011-12-07 |