| NPI | 1295106805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005794) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 18059 - 875) |
| Enumeration Date | 2015-10-08 |
| Last Update Date | 2020-11-16 |