| NPI | 1467890145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 036152796) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL 036152796) |
| 207X00000X Orthopaedic Surgery (Licence: GA 93218) | |
| 207X00000X Orthopaedic Surgery (Licence: TX U0545) | |
| 207XX0005X Orthopaedic Surgery Sports Medicine (Licence: GA 93218) | |
| Enumeration Date | 2013-06-04 |
| Last Update Date | 2025-06-18 |