NPI | 1356716138 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5723) |
Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: GA POD001288) |
Enumeration Date | 2015-12-05 |
Last Update Date | 2021-03-16 |