| NPI | 1023350519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016.005690) |
| Additional Taxonomies | 282N00000X General Acute Care Hospital |
| Enumeration Date | 2013-03-22 |
| Last Update Date | 2021-12-07 |