| NPI | 1477784841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016.005423) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016005423) |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2025-06-03 |