| NPI | 1316089378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: IL 16-002796) |
| Additional Taxonomies | 213ER0200X Podiatrist Radiology (Licence: IL 16-002796) |
| 213ES0000X Podiatrist Sports Medicine (Licence: IL 16-002796) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 16-002796) | |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2008-03-20 |