| NPI | 1629392568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E4881) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E4881) |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CA E4881) | |
| Enumeration Date | 2010-03-22 |
| Last Update Date | 2014-06-10 |