| NPI | 1073078085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016.005918) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: GA POD001404) |
| 213E00000X Podiatrist (Licence: IN 07001343A) | |
| Enumeration Date | 2019-02-04 |
| Last Update Date | 2023-12-04 |