| NPI | 1215440854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MN 1130) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 135.000988) |
| Enumeration Date | 2017-11-06 |
| Last Update Date | 2023-01-12 |