| NPI | 1760469688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC004755L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC004755L) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2024-09-04 |