| NPI | 1497072987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IA 097231) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016005482) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016.005482) | |
| Enumeration Date | 2010-04-23 |
| Last Update Date | 2019-09-05 |