| NPI | 1376578351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E2963) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: NV 2031) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CA E2963) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2018-07-17 |