| NPI | 1801143482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: IL 016005543) |
| Additional Taxonomies | 213EP0504X Podiatrist, Public Medicine (Licence: IL 016005543) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IL 016005543) | |
| 213ER0200X Podiatrist, Radiology (Licence: IL 016005543) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005543) | |
| Enumeration Date | 2012-08-13 |
| Last Update Date | 2013-11-06 |