| NPI | 1730269655 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E4362) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E4362) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E4362) | |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2007-07-08 |