| NPI | 1740368968 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA 000E40820) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: CA RHD147705) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA 03014) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2009-04-08 |