| NPI | 1043213242 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E2415) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E2415) |
| 213ER0200X Podiatrist, Radiology (Licence: CA E2415) | |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E2415) | |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2009-10-30 |