| NPI | 1568088706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 135.001080) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MT 118648) |
| Enumeration Date | 2020-06-23 |
| Last Update Date | 2023-03-27 |