| NPI | 1912975434 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E3954) |
| Additional Taxonomies | 213ES0000X Podiatrist Sports Medicine (Licence: CA E3954) |
| 213ES0103X Podiatrist Foot & Ankle Surgery (Licence: CA E-3954) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2016-02-08 |