| NPI | 1346233541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IA 789) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005214) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2002014364) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2024-01-09 |