| NPI | 1790829992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA FZ216Z) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E14010) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E14010) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2020-04-29 |