| NPI | 1346645496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MO 2015014633) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 016.004215) |
| 213E00000X Podiatrist (Licence: IL 016.004215) | |
| 213E00000X Podiatrist (Licence: MO 2015014633) | |
| Enumeration Date | 2014-10-31 |
| Last Update Date | 2015-09-03 |