| NPI | 1548746761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OH 36.004044) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 135.001023) |
| Enumeration Date | 2018-07-11 |
| Last Update Date | 2024-07-02 |