| NPI | 1780065144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: PA SC006584) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006584) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2022-04-22 |