| NPI | 1548336605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E2603) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: CA RHC116746) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2012-08-01 |