| NPI | 1407171390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E5582) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: IA 000875) |
| Enumeration Date | 2010-04-02 |
| Last Update Date | 2021-02-16 |