| NPI | 1194767921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E2064) |
| Additional Taxonomies | 335E00000X Prosthetic/Orthotic Supplier (Licence: CA E2064) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2008-04-11 |