| NPI | 1609871342 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E3530) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: CA E3530) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E3530) | |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2017-05-09 |