| NPI | 1386641165 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IA 555) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016-004815) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-07-08 |