| NPI | 1235201898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TN 734) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: IL 016-004761) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2013-05-02 |