| NPI | 1912294851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: PA SC006275) |
| Additional Taxonomies | 213ER0200X Podiatrist Radiology (Licence: PA SC006275) |
| 213ES0000X Podiatrist Sports Medicine (Licence: PA SC006275) | |
| Enumeration Date | 2011-06-29 |
| Last Update Date | 2020-02-14 |