| NPI | 1114039369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA 5325) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WI 892-025) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 016005154) | |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2019-11-18 |