| NPI | 1932174224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: MO 2018039584) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 016-005644) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: MD 01291) | |
| Enumeration Date | 2006-02-21 |
| Last Update Date | 2019-11-21 |