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 |