| NPI | 1386746477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E4033) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: OR 228701) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2026-08-26 |