| NPI | 1750486072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC002068L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO 1213) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2007-07-08 |