| NPI | 1245407295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX 1910) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016005365) |
| 213E00000X Podiatrist (Licence: TX 1910) | |
| Enumeration Date | 2008-05-09 |
| Last Update Date | 2022-08-16 |