| NPI | 1043581812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 592) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NC 592) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL bl8403747-wr1120) | |
| Enumeration Date | 2012-01-25 |
| Last Update Date | 2020-10-25 |