| NPI | 1467607077 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E4867) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: UT 510657874) |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2011-07-26 |