| NPI | 1396745659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016005143) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E4724) |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2011-10-21 |