| NPI | 1295998722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: GA POD001431) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E4653) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2019-10-31 |