| NPI | 1588771562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC005967) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC005967) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2018-10-24 |