| NPI | 1679686976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E3477) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: HI PO104) |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2011-02-24 |