| NPI | 1508967621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005216) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016005216) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IL 016005216) | |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2019-09-12 |