| NPI | 1609874015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 016003216) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016003216) |
| Enumeration Date | 2005-07-09 |
| Last Update Date | 2010-01-25 |