| NPI | 1154576239 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E4945) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: IN 41000226A) |
| Enumeration Date | 2008-11-17 |
| Last Update Date | 2011-09-12 |