| NPI | 1932125697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MN 810) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: ND 57) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005270) | |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2022-03-08 |