| NPI | 1598836769 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E2521) |
| Additional Taxonomies | 213EP1101X Podiatrist, Primary Podiatric Medicine (Licence: CA E2521) |
| 213ES0131X (Licence: CA E2521) | |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2012-03-27 |