| NPI | 1598766602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016-003420) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 316000982) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: IL 016-003420) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016003420) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2026-02-12 |