| NPI | 1861476509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC001728L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ 25M000107100) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2007-07-08 |