| NPI | 1588770770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: MO 000553) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: CA E5264) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2021-06-29 |