NPI | 1033475678 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5204) |
Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E-5204) | |
213E00000X Podiatrist (Licence: CA E-5204) | |
Enumeration Date | 2012-04-09 |
Last Update Date | 2016-08-17 |