| NPI | 1376684522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E3314) |
| Additional Taxonomies | 247100000X Radiologic Technologist (Licence: CA RHC126854) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2024-02-14 |