| NPI | 1194089383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: TX 2259) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 135000781) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NC 642) | |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2017-04-05 |