| NPI | 1659366342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 665) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 16005134) |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2011-11-03 |