| NPI | 1093792723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E4634) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA e4634) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WA po807) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2016-10-03 |