| NPI | 1912988833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC003622L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MD MD01269) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2024-02-07 |