| NPI | 1588004865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA 5608) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: MS 80224) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: TX T51-2013) | |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2019-11-20 |