| NPI | 1598700320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: TX 1660) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016005230) |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2023-12-11 |