| NPI | 1750336731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC003660L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00302200) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2022-03-01 |