| NPI | 1265489546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E4331) |
| Additional Taxonomies | 213EP0504X Podiatrist, Public Medicine (Licence: CA E4331) |
| 213ER0200X Podiatrist, Radiology (Licence: CA E4331) | |
| 213ES0000X Podiatrist, Sports Medicine (Licence: CA E4331) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CA E4331) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2007-12-19 |