NPI | 1578660593 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016005003) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005003) |
Enumeration Date | 2006-09-20 |
Last Update Date | 2021-03-29 |