| NPI | 1386445559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 135.011505) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA 11235813) |
| Enumeration Date | 2025-03-22 |
| Last Update Date | 2026-06-24 |