| NPI | 1871807248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 0103301202) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005558) |
| 213E00000X Podiatrist (Licence: IL 016005558) | |
| 213E00000X Podiatrist (Licence: VA 0103301202) | |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2017-04-24 |