| NPI | 1427437029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E5427) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: FL PO3878) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2018-09-18 |