| NPI | 1205198157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MN 1041) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 016.005571) |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2021-02-12 |