| NPI | 1831398015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: DE E1-0000189) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006160) |
| 213E00000X Podiatrist (Licence: NJ 25MD000292400) | |
| Enumeration Date | 2007-07-17 |
| Last Update Date | 2020-07-13 |