| NPI | 1649238288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC002758L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 36002247M) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2007-11-08 |