| NPI | 1720134422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016004656) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07000775) |
| Enumeration Date | 2007-01-26 |
| Last Update Date | 2019-01-22 |