| NPI | 1578946182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5511) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: PA SC006662) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2020-07-03 |