| NPI | 1871756148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E4177) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E4177) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2024-03-11 |