| NPI | 1831195841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005211) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016005211) |
| 213EP0504X Podiatrist, Public Medicine (Licence: IL 016005211) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: IL 016-005211) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: IL 016-005211) | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2021-06-23 |