| NPI | 1174552541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E4038) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E4038) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E4038) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2021-01-17 |