| NPI | 1396874061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E2026) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E2026) |
| 213ES0000X Podiatrist Sports Medicine (Licence: CA E2026) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: CA E2026) | |
| Enumeration Date | 2007-03-05 |
| Last Update Date | 2010-07-19 |