| NPI | 1225010648 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist Foot Surgery (Licence: CA E2485) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E2485) |
| Enumeration Date | 2005-11-20 |
| Last Update Date | 2020-03-03 |