| NPI | 1194940106 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016.003027) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IL 316.000674) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2013-02-06 |