| NPI | 1053763664 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016.005777) |
| Additional Taxonomies | 213ES0131X (Licence: IL 016005777) |
| Enumeration Date | 2016-07-07 |
| Last Update Date | 2024-12-12 |