| NPI | 1528245800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E4766) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E4766) |
| 213ER0200X Podiatrist, Radiology (Licence: CA RHC00201402) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E4766) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CA E4766) | |
| Enumeration Date | 2008-01-29 |
| Last Update Date | 2021-12-17 |