| NPI | 1912261652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CO POD.0000749) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 135000764) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2018-12-06 |