| NPI | 1851877179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA sc006928) |
| Additional Taxonomies | 213EP0504X Podiatrist, Public Medicine (Licence: PA Sc006928) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA sc006928) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: PA sc006928) | |
| 213ER0200X Podiatrist, Radiology (Licence: PA SC006928) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: PA sc006928) | |
| 261QP1100X Clinic/Center, Podiatric (Licence: PA SC006928) | |
| Enumeration Date | 2018-07-19 |
| Last Update Date | 2022-08-10 |