| NPI | 1790760494 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: IL 016.005443) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: MO 2010030718) |
| Enumeration Date | 2005-12-14 |
| Last Update Date | 2020-10-07 |