| NPI | 1891140562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NH 0369) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 135.000903) |
| Enumeration Date | 2016-04-29 |
| Last Update Date | 2019-05-08 |