| NPI | 1508885278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E4426) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: CA E4426) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2015-01-30 |