| NPI | 1205835410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07001141A) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016004836) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2014-12-15 |