| NPI | 1598386286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC007114) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: PA SC007114) |
| Enumeration Date | 2020-05-04 |
| Last Update Date | 2026-05-15 |