| NPI | 1376540534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: CA E2853) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E2835) |
| 213E00000X Podiatrist (Licence: CA E2835) | |
| Enumeration Date | 2005-07-03 |
| Last Update Date | 2007-07-08 |