| NPI | 1174502868 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IL 016005201) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005201) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2020-04-14 |