| NPI | 1184773764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E4829) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA EL 1665) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: WA PO60106729) | |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2020-05-28 |