| NPI | 1457452476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: ID 3271756) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 10140276-0501) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005082) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2025-06-17 |