| NPI | 1811419161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006870) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006870) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: PA SC006870) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: PA SC006870) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: PA SC006870) | |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2022-05-10 |