| NPI | 1932111879 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E5178) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: MO 2006039218) |
| 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E-5178) | |
| 213E00000X Podiatrist (Licence: KS 12-00378) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2026-02-24 |