| NPI | 1801858048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E3289) |
| Additional Taxonomies | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: CA E3289) |
| 213ES0000X Podiatrist Sports Medicine (Licence: CA E3289) | |
| 213ES0131X Podiatrist Foot Surgery (Licence: CA E3289) | |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2016-08-31 |