| NPI | 1295766475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: CA E4222) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: CA E4222) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2009-11-23 |