| NPI | 1104829431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E3467) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E34670) |
| 213ER0200X Podiatrist, Radiology (Licence: CA E3467) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2010-05-19 |