NPI | 1811884083 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IL 135001254) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 135001254) |
213ES0131X (Licence: IL 135001254) | |
Enumeration Date | 2025-06-20 |
Last Update Date | 2025-06-20 |