| NPI | 1083015580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E5347) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CO 0000543) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2018-05-31 |