| NPI | 1396476628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E6124) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: TX T18-2022) |
| 213E00000X Podiatrist (Licence: CA E6124) | |
| Enumeration Date | 2022-06-17 |
| Last Update Date | 2025-06-09 |