| NPI | 1346264595 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA BK5973842) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E4062) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-05-22 |