| NPI | 1972584464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016003708) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: FL PO 3467) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2014-06-11 |