| NPI | 1558476739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IL 016004658) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IA 00545) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2023-03-07 |