| NPI | 1699833020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E3548) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E3548) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: CA E3548) | |
| Enumeration Date | 2006-12-05 |
| Last Update Date | 2010-09-23 |