| NPI | 1427331347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016.005508) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: NY R71128) |
| 213E00000X Podiatrist (Licence: PA SC006242) | |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2020-10-30 |