| NPI | 1124052717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016.005534) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: OH 003440) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2013-01-07 |