| NPI | 1689627879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA 5321) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IL 016005096) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA 5321) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2024-05-09 |