| NPI | 1750478012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IN 07000497) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016003243) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2008-03-18 |