| 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 |