| NPI | 1972569515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: PA SC002367L) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO0001394) |
| 213E00000X Podiatrist (Licence: AZ 0200) | |
| Enumeration Date | 2006-04-22 |
| Last Update Date | 2007-11-15 |