| NPI | 1811127673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD001207) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 135000690) |
| Enumeration Date | 2009-07-15 |
| Last Update Date | 2012-09-27 |