| NPI | 1932253689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: DE E10000193) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC005870) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2018-09-06 |