| NPI | 1568877819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016.005658) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: IL 135000848) |
| Enumeration Date | 2014-06-25 |
| Last Update Date | 2017-12-01 |