| NPI | 1326002064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA 3854) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E03854) |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2024-04-27 |