| NPI | 1881679983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: PA SC002989L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC002989L) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: PA SC002989L) | |
| Enumeration Date | 2005-12-12 |
| Last Update Date | 2016-03-03 |