| NPI | 1245684166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: NV 2076) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: CA E5561) |
| Enumeration Date | 2016-04-18 |
| Last Update Date | 2023-07-21 |