| NPI | 1942212956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA Sc002095L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA Sc002095L) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: PA Sc002095L) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2014-02-07 |