| NPI | 1144396607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5607) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 32830) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2021-12-17 |