| NPI | 1821166810 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016002959) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: IL 178-001404) |
| Enumeration Date | 2006-11-30 |
| Last Update Date | 2010-11-10 |