| NPI | 1871547471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC-003623-L) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NJ 25MD00202100) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2015-11-10 |