| NPI | 1073872859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: AZ POD000836) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: AZ 0836) |
| 213E00000X Podiatrist (Licence: IL 016005677) | |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 016005677) | |
| Enumeration Date | 2012-05-14 |
| Last Update Date | 2020-11-06 |