| NPI | 1972614451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 360) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016002757) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2014-06-09 |