| NPI | 1568715225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E5203) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 135000788) |
| Enumeration Date | 2012-10-18 |
| Last Update Date | 2015-08-07 |