| NPI | 1114977907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 2363) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 16005108) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IN 07001021A) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2019-04-03 |