| NPI | 1912294711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E5146) |
| Additional Taxonomies | 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E5146) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2015-04-30 |