| NPI | 1780788190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: IN 07000758) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: IL 016003079) |
| Enumeration Date | 2006-09-08 |
| Last Update Date | 2007-07-08 |