| NPI | 1023545407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E6136) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: DE E1-0010266) |
| Enumeration Date | 2017-05-17 |
| Last Update Date | 2025-06-10 |