| NPI | 1417925322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0131X Podiatrist, Foot Surgery (Licence: CA E21270) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E2127) |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2010-12-15 |