| NPI | 1346234457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E3543) |
| Additional Taxonomies | 213ES0000X Podiatrist, Sports Medicine (Licence: CA E3543) |
| Enumeration Date | 2005-09-02 |
| Last Update Date | 2009-12-17 |