| NPI | 1831152339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC0001789L) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: PA SC001789L) |
| 213ER0200X Podiatrist, Radiology (Licence: PA SC001789L) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: PA SC001789L) | |
| 213ES0131X (Licence: PA SC001789L) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2007-11-07 |