| NPI | 1770641615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC004224L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25MD00249300) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2013-06-10 |