| NPI | 1538655279 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E5837) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E5837) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5837) | |
| Enumeration Date | 2018-07-05 |
| Last Update Date | 2024-10-15 |