| NPI | 1922072701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016003942) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MO 000545) |
| Enumeration Date | 2006-02-16 |
| Last Update Date | 2011-11-14 |