| NPI | 1366428310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E2951) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E2951) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: CA E2951) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2013-06-25 |