| NPI | 1871598748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E4536) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E4536) |
| 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E4536) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2012-12-18 |