| NPI | 1265845010 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: ND 82) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016005716) |
| Enumeration Date | 2014-06-10 |
| Last Update Date | 2020-04-28 |