| NPI | 1679872725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0000X Podiatrist, Sports Medicine (Licence: CA EL1830) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA EL1830) |
| Enumeration Date | 2011-03-15 |
| Last Update Date | 2021-11-29 |