| NPI | 1366591000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: NM 308) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E4696) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2010-03-08 |