| NPI | 1902829864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC001524L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NJ Z5MD00138800) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2013-03-04 |