| NPI | 1750796660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 213E00000X Podiatrist (Licence: CA 5328) |
| Additional Taxonomies | 213E00000X Podiatrist (Licence: WI 17944-875) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2021-06-18 |