| NPI | 1902469059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E5860) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: LA 337964) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2023-09-12 |