| NPI | 1679666580 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC003071L) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC003071L) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2014-01-13 |