| NPI | 1750449526 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: AL 300) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC003685L) |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2016-12-15 |