| NPI | 1629223110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: ID P-255) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006038) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC006038) | |
| Enumeration Date | 2008-11-25 |
| Last Update Date | 2020-09-11 |