| NPI | 1568459030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: IL 016-002956) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IL 016-002956) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: IL 016-0002956) | |
| 213ER0200X Podiatrist, Radiology (Licence: IL 016-002956) | |
| 213E00000X Podiatrist (Licence: IL 016-0002956) | |
| Enumeration Date | 2005-09-30 |
| Last Update Date | 2016-10-18 |