| NPI | 1033748512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016.006070) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC007108) | |
| Enumeration Date | 2020-04-06 |
| Last Update Date | 2024-07-22 |