| NPI | 1962796631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005839) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: FL PO3872) |
| Enumeration Date | 2011-05-30 |
| Last Update Date | 2022-11-20 |