| NPI | 1710328224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 016.005737) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IA 000878) |
| Enumeration Date | 2013-07-12 |
| Last Update Date | 2020-08-05 |