| NPI | 1841378361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: WI 825-025) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016-005044) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |