| NPI | 1689978397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E5659) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: AZ 0817) |
| 213E00000X Podiatrist (Licence: AZ 0817) | |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2021-03-26 |