| NPI | 1821203548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016003156) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016003156) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2014-06-30 |