| NPI | 1558046060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 135.001185) |
| Additional Taxonomies | 207X00000X Orthopaedic Surgery (Licence: IL 135.001185) |
| Enumeration Date | 2023-06-21 |
| Last Update Date | 2023-09-19 |