| NPI | 1629076021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016005256) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MO 2008005998) |
| 213E00000X Podiatrist (Licence: FL PO3090) | |
| Enumeration Date | 2005-07-09 |
| Last Update Date | 2023-10-11 |