| NPI | 1679197644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IL 135.001103) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016006018) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2020-06-04 |
| Last Update Date | 2023-07-10 |