| NPI | 1649200502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 16005263) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NY 6057) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MO 2006013232) | |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2020-02-05 |