| NPI | 1902884950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: PA SC003442L) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC003442L) |
| 213E00000X Podiatrist (Licence: PA SC003442L) | |
| 213ER0200X Podiatrist, Radiology (Licence: PA SC003442L) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2011-05-05 |