| NPI | 1255366779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E4526) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: CA E4526) |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2023-02-03 |