| NPI | 1043428634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: UT 11633905-0501) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E 4727) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA el 1582) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2021-07-30 |