| NPI | 1225148794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E1885) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: CA E1885) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |