| NPI | 1346482445 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: CA E1275) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: CA E1275) |
| Enumeration Date | 2009-04-03 |
| Last Update Date | 2009-04-03 |