| NPI | 1093706590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E3866) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: CA E3866) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2011-10-05 |