| NPI | 1538163456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016.003832) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016003832) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2021-06-22 |