| NPI | 1104825033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E4031) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E4031) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2020-09-29 |