| NPI | 1114281557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E5223) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006406) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5223) | |
| Enumeration Date | 2012-06-29 |
| Last Update Date | 2016-08-05 |