| NPI | 1316151590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E1735) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E1735) |
| 213ER0200X Podiatrist, Radiology (Licence: CA E1735) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E1735) | |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2011-01-18 |