| NPI | 1760631642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC006093) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E4996) |
| 213E00000X Podiatrist (Licence: WI 979-025) | |
| Enumeration Date | 2008-09-16 |
| Last Update Date | 2016-01-05 |