| NPI | 1972587350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: FL PO1322) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CO 421) |
| 213E00000X Podiatrist (Licence: IL 016003144) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2023-05-12 |