| NPI | 1649660770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E5160) |
| Additional Taxonomies | 213ES0131X Podiatrist, Foot Surgery (Licence: CA E5160) |
| Enumeration Date | 2015-01-27 |
| Last Update Date | 2015-01-27 |