| NPI | 1023470754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005762) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016005762) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IL 016005762) | |
| 213ER0200X Podiatrist, Radiology (Licence: IL 016005762) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: IL 016005762) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: IL 016005732) | |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-07-21 |