| NPI | 1659370062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 016004128) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IN 07000739A) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2014-11-19 |