| NPI | 1881624872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016004788) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016004788) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: IL 016004788) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2011-01-13 |