| NPI | 1669808739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA e5109) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program (Licence: CA EL1891) |
| Enumeration Date | 2013-09-22 |
| Last Update Date | 2021-12-02 |