NPI | 1689687204 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: PA SC002893L) |
Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC-002893-L) |
Enumeration Date | 2006-08-14 |
Last Update Date | 2022-07-21 |