| NPI | 1821409632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC006938) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery Foot and Ankle Surgery (Licence: PA SC006938) |
| 213E00000X Podiatrist (Licence: PA SC006938) | |
| Enumeration Date | 2014-05-14 |
| Last Update Date | 2024-08-20 |