| NPI | 1780868521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 16-2918) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| 246Z00000X Specialist/Technologist, Other | |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2007-12-27 |