| NPI | 1982243432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 1305) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC007059) |
| Enumeration Date | 2020-01-02 |
| Last Update Date | 2023-02-21 |