| NPI | 1639178718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07000801) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016004365) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2024-03-12 |