| NPI | 1700872595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016004820) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IL 016004820) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: IL 016004820) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016004820) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: IL 016004820) | |
| Enumeration Date | 2005-09-27 |
| Last Update Date | 2023-08-04 |