| NPI | 1285128074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016.005930) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY p10756) |
| 213E00000X Podiatrist (Licence: WI 1183-25) | |
| Enumeration Date | 2018-06-15 |
| Last Update Date | 2021-12-29 |