| NPI | 1265696777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X (Licence: IL 016005403) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016005403) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005403) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2026-06-10 |