| NPI | 1558325563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E2978) |
| Additional Taxonomies | 213ER0200X Podiatrist, Radiology (Licence: CA RHC120923) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2014-03-21 |