| NPI | 1184939035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: KY 269121) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016005536) |
| 213E00000X Podiatrist (Licence: IL 135000724) | |
| Enumeration Date | 2010-08-16 |
| Last Update Date | 2023-11-16 |