| NPI | 1154055176 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: OR DP224419) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA EL7071) |
| Enumeration Date | 2022-07-14 |
| Last Update Date | 2025-11-14 |