| NPI | 1811476658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA e5807) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA e5807) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA e5807) | |
| Enumeration Date | 2018-08-13 |
| Last Update Date | 2021-10-07 |