| NPI | 1962443507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016003403) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 797025) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2014-05-15 |