| NPI | 1710405675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: PA SC007232) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: NJ 25MD00354500) |
| Enumeration Date | 2017-08-31 |
| Last Update Date | 2022-11-23 |