| NPI | 1740213024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: DE E10000085) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC004005L) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2014-09-11 |