| NPI | 1831402155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5027) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 1307-25) |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2025-08-19 |