| NPI | 1710339023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA E5598) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: PA SC006764) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2023-09-26 |