| NPI | 1326040981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 2000161055) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016005192) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2017-02-09 |