| NPI | 1881679272 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC004259L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AL 202) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2020-02-14 |