| NPI | 1518205012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E-5045) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: NY N006529) |
| Enumeration Date | 2013-01-18 |
| Last Update Date | 2014-08-15 |