| NPI | 1558310904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016005231) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IN 07001088A) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2015-05-22 |