| NPI | 1700178092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016005597) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005597) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CO 0000766) | |
| Enumeration Date | 2011-05-05 |
| Last Update Date | 2016-07-27 |