| NPI | 1528590924 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: NC 741) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 741) |
| 213E00000X Podiatrist (Licence: IL 135.000956) | |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2020-07-22 |