| NPI | 1245260108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: KY 00328) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016005078) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: KY 00328) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2024-05-01 |