| NPI | 1144226036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 2186) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY N006070-1) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016.005325) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2005012314) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2023-03-07 |