| NPI | 1508972290 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist Primary Podiatric Medicine (Licence: CA E1867) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA 000E18670) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2021-05-14 |