| NPI | 1154618122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5117) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: FL Resident) |
| Enumeration Date | 2011-06-28 |
| Last Update Date | 2021-11-08 |