| NPI | 1831452002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E5143) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA EL1906) |
| Enumeration Date | 2012-06-21 |
| Last Update Date | 2022-07-21 |