| NPI | 1780051490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO4577) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 135001129) |
| Enumeration Date | 2015-08-28 |
| Last Update Date | 2024-07-08 |