| NPI | 1316997042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016004115) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MS 80087) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2019-01-22 |