| NPI | 1609179845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC006252) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MN 1010) |
| Enumeration Date | 2010-12-09 |
| Last Update Date | 2023-02-16 |