| NPI | 1891923033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006125) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CO POD.0000717) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2026-04-08 |