| NPI | 1740918960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA 6209) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: VA 116037299) |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2026-05-22 |