NPI | 1831197052 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016002624) |
Additional Taxonomies | 332B00000X Durable Medical Equipment & Medical Supplies |
Enumeration Date | 2005-07-12 |
Last Update Date | 2014-01-21 |