| NPI | 1972919702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016005674) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IL 016.005674) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 1308) | |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2024-01-17 |