| NPI | 1154319838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 525) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016003222) |
| Enumeration Date | 2005-10-07 |
| Last Update Date | 2019-09-21 |