| NPI | 1689622177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA 000E23120) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA 000E23120) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2009-03-17 |