| NPI | 1760624860 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC006099) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006099) |
| Enumeration Date | 2009-04-03 |
| Last Update Date | 2023-09-25 |