| NPI | 1588943708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OR DP167643) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 135.000733) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: OR DP167643) | |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2021-01-05 |