| NPI | 1427092055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016-004762) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MO 2005039419) |
| 213E00000X Podiatrist (Licence: WI 873-025) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2019-07-23 |