| NPI | 1053669226 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5065) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016.005504) |
| Enumeration Date | 2012-08-20 |
| Last Update Date | 2020-06-30 |