| NPI | 1528563483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016.005959) |
| Additional Taxonomies | 207XX0004X Orthopaedic Surgery, Foot and Ankle Surgery (Licence: IL 1) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 135.000999) | |
| Enumeration Date | 2018-03-24 |
| Last Update Date | 2023-08-09 |