| NPI | 1871729848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC002075L) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: PA SC002075L) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2010-08-06 |