| NPI | 1952718975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC006603) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: HI PO-214) |
| 213E00000X Podiatrist (Licence: DE E1-0010276) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CT 1141) | |
| Enumeration Date | 2014-07-22 |
| Last Update Date | 2024-04-23 |