| NPI | 1972617629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 1127-25) |
| Additional Taxonomies | 111N00000X Chiropractor (Licence: WI 3880-012) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 135000875) | |
| Enumeration Date | 2006-08-19 |
| Last Update Date | 2018-04-26 |