| NPI | 1740399765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NE 342) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 016005313) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IA 00799) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2015-02-10 |