| NPI | 1679143036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC007198) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: PA SC007198) |
| Enumeration Date | 2021-06-29 |
| Last Update Date | 2024-06-18 |