| NPI | 1881797223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: FL PO4119) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MI 5901001493) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IL 016005264) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2020-02-27 |