| NPI | 1962408864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: IL 016003617) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: IL 016-003617) |
| 213E00000X Podiatrist (Licence: IL 016003617) | |
| 213EP0504X Podiatrist Public Medicine (Licence: IL 016003617) | |
| 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: IL 016-003617) | |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2021-12-20 |