| NPI | 1467436808 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016003058) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: IL 016003058) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016003058) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2021-12-23 |