| NPI | 1497868962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016005020) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 856-025) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2015-08-12 |