| NPI | 1467684423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: SD 210) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA EL 1809) |
| 213E00000X Podiatrist (Licence: SD 210) | |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2022-04-04 |