| NPI | 1679554778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E3476) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: CA E3476) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2020-06-22 |