| NPI | 1629015813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NC 511) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016005324) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: OH 36-00-3422) | |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2022-08-24 |