| NPI | 1043263171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 061-0049911) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016-004911) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2023-12-05 |