| NPI | 1588678130 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E3910) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: CA e3910) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2020-02-28 |