| NPI | 1396839965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA e4307) |
| Additional Taxonomies | 193400000X Single Specialty (Licence: CA e4307) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2016-11-28 |