| NPI | 1982834347 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: CA E4975) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA EL1784) |
| Enumeration Date | 2009-07-20 |
| Last Update Date | 2025-09-03 |