| NPI | 1912197146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WV 10477) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC006026) |
| Enumeration Date | 2007-07-25 |
| Last Update Date | 2020-10-15 |