| NPI | 1043521719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016.005608) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2010021578) |
| Enumeration Date | 2010-06-28 |
| Last Update Date | 2016-11-17 |