| NPI | 1750392957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016-003011) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO 3501) |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2012-09-24 |