| NPI | 1871560235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD001499) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016004441) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001499) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2022-05-24 |