| NPI | 1700812732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016003705) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 707-25) |
| Enumeration Date | 2006-06-23 |
| Last Update Date | 2016-12-06 |