| NPI | 1871617969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: IL 316000660) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016.003002) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2008-09-24 |