| NPI | 1609849934 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: PA SC001282L) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: PA SC001282L) |
| 213ER0200X Podiatrist, Radiology (Licence: PA SC001282L) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC001282L) | |
| Enumeration Date | 2006-02-08 |
| Last Update Date | 2010-06-30 |