| NPI | 1124412184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO61142698) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 016005850) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MA 1348) | |
| Enumeration Date | 2015-03-26 |
| Last Update Date | 2021-12-04 |