| NPI | 1801983374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA e3911) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: CA E3911) |
| 213ES0000X Podiatrist, Sports Medicine (Licence: CA e3911) | |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E3911) | |
| 213ES0131X Podiatrist, Foot Surgery (Licence: CA E3911) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2020-01-07 |