| NPI | 1750331252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E2715) |
| Additional Taxonomies | 213ES0131X Podiatrist Foot Surgery (Licence: CA E2715) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2007-07-08 |