| NPI | 1639300486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07000570A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC002269L) |
| Enumeration Date | 2009-07-28 |
| Last Update Date | 2013-01-22 |