NPI | 1942208558 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 016004770) |
Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016-004770) |
Enumeration Date | 2005-07-08 |
Last Update Date | 2021-07-16 |